Bob K | Nexus Insights

The past 18 months have been tragic for residents of senior living communities, their families, and their staff. As we begin to gain control of the pandemic, we must begin to think about the future of senior living, and decide how to move forward to avoid the mistakes of the past.

To answer that important question, Patrick Bultema, CEO of The Eden Alternative and Penny Cook, CEO of Pioneer Network gathered some of the leading thinkers in the industry for a podcast, entitled “Better Together: Given the impact of COVID, what comes next?” This lively roundtable featured Lori Smetanka, Executive Director of Consumer Voice, and two Nexus Fellows, Bob Kramer, Founder & Fellow of Nexus Insights and Strategic Advisor & Co-founder of NIC and Dr. Bill Thomas, Founder of The Eden Alternative, The Greenhouse Project and Minka. Together, these five industry experts tackled the issues that ail our current aging service industry, and presented recommendations for the changes needed in order for it to succeed, going forward.

Highlights and Key Take-Aways:

We must stop taking our frontline health care workers for granted.

COVID has been a wake-up call. Although we cheer for hospital workers, we don’t give them enough support. They have been working the most dangerous jobs in America. We cannot go back to the days of taking frontline workers for granted. To maintain a high quality of care, the people providing services need support in the form of training, living wages and benefits, and career ladders. And there must be accountability from providers on how they are using public monies and funds.

We must create home and community-based models of care.

More than 90% of those infected contended with the illness at home, surrounded by family. Although people can care for themselves or their families at home, or receive all needed services in age-segregated congregate living settings, we have created an empty lane in the middle – between pure age segregation and pure aging in place. Access to services are needed that are focused on wellness and supported by people’s home and community-based shared benefits.”

Communities must engage residents and families in asking what they want.

People were frantic, particularly residents and family in SNF and ALFs, for safety, isolation and inability to connect. People were being told to stay home. One of the residents in a community remarked, “But what if your home is a death trap?”

When we look at long-term care, there isn’t a whole lot of preparation or proactive thought about what people need and want in the future. People need options, they want to be engaged in the community similar to how they lived before and they certainly don’t want to rely on the facility van to take them out. Lack of quality of life during the pandemic meant being kept in their rooms with the curtains and the door shut. These communities are not engaging residents or family in asking what they want. Residents and family should be included in the strategic planning. Which services do they want or need? It’s important to get feedback.

“But what if your home is a death trap?”

Transparency must be a requirement.

Transparency is critical. Providers may not have wanted to share information about COVID cases or deaths, and in fact, some chose to suppress that information. But family and residents needed that info to make decisions for themselves and their loved ones.

We must rethink the way we think and talk about aging.

What do we really offer in senior living? We have to rethink our basic terminology. The way that we think about aging, health, retirement, healthcare, diversity. Many terms are ageist and self-defeating, and not what we actually want for our residents. If we don’t change something, we are going to get disrupted right out of business. Senior Living represents to boomers what they did with their parents and they want nothing to do with it.

COVID showed us that we need to give people a sense of being connected and belonging. What are your goals in moving here? Where do you want to grow? Where do you want to contribute here. It’s wrong to think that the older you are, the more helpless you are, the less you have to give. With technology we can transform the sense of home, and help individuals remain safe, healthier and connected for longer.

Senior living represents to Boomers what they did with their parents, and they want nothing to do with it.

Funding is critical to success.

Although skilled nursing has gotten a lot of public support dollars, that’s not true of others. How many can survive with expenses way exceeding revenues? The weak have gotten weaker. Many companies do not have the funds to invest in the necessary people and technologies. When it comes specifically to long-term care, we have got to have a real conversation about how we are addressing ageism as a nation. Do we care as a nation if our elders die in poverty? If we do care, we have to figure out a way to fund long-term care.

We must solve the caregiver crisis.

The number of family caregivers is the biggest demographic shift in this decade. It’s not the increase in the aging population, it’s the ratio of unpaid caregivers, aged 45-64, to those over 80, which is going from decreasing from a ratio of 7 to 1 to a ratio of 4 to 1 by 2030. Where will the paid caregivers come from? They are going to be more expensive. Saying everyone is going to age in place without funding will lead to an epidemic of shut-ins and loneliness in their own apartments rather than truly creating a community and honoring our elders.

Do we care as a nation if our elders die in poverty? If we do care, we have to figure out a way to fund long-term care.

People want choices, but they must be affordable.

Aging in place is something everyone wants. They want to choose where they live, whether it’s a community or in their own homes with services brought to them. There needs to be a variety of choices. Most people can’t pay 80, 90, or 100 thousand dollars for assisted living or skilled nursing. There’s a lot of waste in the system, where the dollars are being spent. People need to be a part of the decision making, planning, providing solutions for themselves. They don’t want to be put in a bed and forgotten and left, which could happen anywhere. How can the community come together to help individuals needing care?

We must invest in social capital.

If we try to spend our way through the aging of the boomer generation, new sources of capital need to be deployed. The largest reservoir of capital is social capital. This is the good that comes into your life through your friends, family, neighbors, people that are willing to make social investments because of a relationship. The biggest issue with aging in place is aging in the right place. If you pursue a rigorous commitment to aging in place, you end up isolating people and their stock of social capital falls. If you end up with congregate care settings, they are not rich in social capital. They create some fellowship and facilitate interaction, but do not foster interdependence amongst their residents and staff – they are not set up that way. This middle lane will succeed based on new models to create, sustain, nourish and enrich social capital. Housing is important, but community is more important.

Watch the entire podcast:

Want to be notified when a new blog is posted? Subscribe to our blog and receive posts in your inbox.

Are your residents truly known, valued, and seen as people by your staff? Are they known as more than the sum of their ADL needs or underlying health conditions?

Bob Kramer, Founder & Fellow at Nexus Insights and Co-founder and Strategic Advisor for NIC, talked with Jay Newton-Small, founder and CEO of MemoryWell and Nexus Fellow, about the value of data to deliver improved care and quality of life for residents of senior living.

A TIME contributor, Newton-Small developed the concept for MemoryWell from her own experience with her father. She wrote a narrative story of his life to help his care staff understand him better, and to provide better, more personalized care.

Now her company has taken it further, working with senior living communities to foster connections between residents and other residents, and between residents and staff, based on connections, interests, lifestyle, and historical experiences revealed by their life stories. The company is able to help communities understand what services are needed, and who would most likely use or benefit from those services.

“We shine the light to help you see who are the people you’re serving.” – Jay Newton-Small

“Where we are now is a shot in the dark,” said Newton-Small. “We shine the light to help you see who are the people you’re serving. So you can market, plan, sell and care for these people in a more focused way, that takes the guesswork out of it.”

The data has other powerful uses as well, which Newton-Small describes in the interview, which aired on Foresight TV. It can be used to get to the root causes of health issues. And, when aggregated, can be used in a predictive way, to help with prevention. “Right now our health care system is a reactive system. It’s an incredibly expensive system because we react to a problem,” said Newton-Small. “But if we know that a problem is coming down the pike and we can match people with resources that are available, then we can delay, defer and even sometimes prevent those problems from happening.”

See the whole interview.